Until the beginning of the twentieth century, unless complications developed, a pregnant woman did not consult her midwife or doctor until she went into labour. The idea of antenatal care arose from the realization that many complications could be prevented if mothers-to-be were seen and examined throughout pregnancy. Modern antenatal care starts early and aims not only at preventing complications, but also at keeping the mother-to-be fit and happy. Today she can approach labour with the quiet confidence that comes from proper antenatal care and a knowledge of what will happen to her in labour and who will be looking after her. With this understanding of what is happening during pregnancy, women are better equipped to take care of their health and that of their unborn child. Since knowledge relieves many of the common anxieties, it is very important that during the antenatal period the mother-to-be comes to understand the processes of pregnancy and labour.
Regular antenatal examinations are the cornerstone of modern obstetric care, so regular visits to the antenatal clinic, however boring or tedious they may seem, are vital to the expectant mother’s and baby’s well-being. If the mother-to-be is unable to keep a particular appointment, she should tell the doctor or midwife so that an alternative appointment can be arranged. Failure to do this is not only unfair to the doctor or midwife, but to the baby and the mother-to-be herself. As soon as a woman thinks she may be pregnant she should consult her doctor and have the pregnancy confirmed. This will normally be two to three weeks after the first period is missed, i.e. six to seven weeks after the last menstrual period. Once pregnancy has been diagnosed, an appointment should be made for the first proper antenatal visit.
In most cases this will involve a trip to the hospital booking antenatal clinic. This usually takes place ten to twelve weeks after the last menstrual period. Women who feel well in early pregnancy often postpone the first visit to the doctor, but this is misguided. A simple examination in early pregnancy is very helpful in detecting complications and establishing that the foetus is developing normally. The first visit to the antenatal clinic is an exciting event for every pregnant woman. Exciting because having succeeded in becoming pregnant she will be anxious to be reassured that all is well and that she has nothing to fear in the six months or so that follow.
Antenatal clinics are usually very busy and, unfortunately, harassed doctors and midwives sometimes overlook the fact that the Woman making her first visit may be apprehensive and worried. Fortunately, however, most clinics are happy places and the large number of patients, overcrowded accommodation and insufficient staff and equipment are cheerfully accepted by the team running them. A welcoming attitude by the staff helps to make the long wait more acceptable and certainly allays apprehension.
Fear of what may happen to her may make the antenatal patient impatient and aggressive so that friction develops. An understanding of the problems by both sides leads to better relationships and, incidentally, more efficient antenatal care which, after all, is to the final benefit of expectant mother, baby and clinic staff.
Inevitably, a form will need to be filled in. The form, in this case, is an antenatal record sheet. On it the midwife or doctor interviewing the patient will enter the essential details of past medical or obstetric problems and of the history of the present pregnancy so far. It helps if the patient can remember the details of her medical history and especially the date of her last menstrual period which is important in calculating the expected date of delivery. The simple sum, assuming a regular twenty-eight day cycle, is First day of last menstrual period, plus seven days, minus three calendar months, equals expected date of delivery e.g. LMP 13.4.78 = EDD 20.1.79.
Once the form is filled, the clinical examination and various tests will be carried out. What the doctor wants to know about a pregnant woman is (1) is she healthy? (2) is the pregnancy proceeding normally? In order to answer the first question the doctor will carry out a general examination of the woman, paying particular attention to the heart and lungs and breasts. Weight and height are also important and will be measured.
The second question is answered by the doctor examining the abdomen to feel if the uterus is growing up from the pelvis as it should do from twelve weeks onwards. The size of the uterus has to be confirmed by a vaginal examination. For this, the doctor inserts his first (or first and second) Fingers into the vagina and feels the uterus between his fingers and his other hand which is placed on the lower part of the abdomen. The vaginal examination also gives the doctor a chance to feel the ovaries and tubes alongside the uterus and detect any abnormality, such as an ovarian.
Finally, the doctor will feel the bony part of the woman’s pelvis to try to assess whether or not it is likely to be big enough to allow the passage of a normal sized baby in labour. As well as the clinical examination a series of special tests will be carried out on every mother-to-be to check that everything is going well with her and the foetus.
At every antenatal visit a specimen of urine is tested for protein (albumin) and glucose (sugar). This is a simple way of knowing if the patient is developingor diabetes. Sugar in the urine is common in pregnancy, but sometimes it is due to the fact that the mother-to-be is developing diabetes. Because infection of the urine is more common in pregnancy than at other times, many hospitals also test urine for germs at the first visit.
A sample of blood is taken by inserting a needle into the vein in the front of the arm and drawing small quantity of blood into a syringe. A number of tests are then carried out on the blood.
It is very important to know the blood group of the mother-to-be in case a transfusion should be needed. The blood group is in two parts: the A, B, O group, in which the patient is either group A or O (the commonest) or B or AB (the least common). The second part of the blood group is thegroup and the patient is either rhesus positive or rhesus negative. Being rhesus negative used to be quite a serious matter because rhesus antibodies could sometimes form in second and subsequent pregnancies in rhesus negative women and harm a rhesus positive baby causing anaemia and . This can now be prevented by a suitable injection after delivery.
The amount of haemoglobin in each blood cell determines its ability to carry oxygen around the body. W/hen the haemoglobin level is low the patient is anaemic. Anaemia results from a lack of iron and folic acid in most cases. In such cases the haemoglobin level falls below the normal one hundred per cent. In pregnant women a haemoglobin of eighty per cent or more is normal because retention of water during pregnancy dilutes the blood. .
Test for Syphilis
Although syphilis is very uncommon nowadays, in pregnant women, it is, nevertheless, such a serious condition that all pregnant women’s blood is tested to make sure that they are free of syphilitic infection. The test that is usually carried out is called the Kahn test. This ensures no undiagnosed infection.